Pediatric ADHD Evaluation Template

An ADHD diagnosis is the pediatric note most likely to be questioned later, by a school, a payer, or another clinician. This two-page template follows the AAP clinical practice guideline for ages 4 through 18. Page one carries the DSM-5 symptom criteria with the counts, the onset-before-age-12 and six-month duration requirements, a rating-scale table for informants across settings, functional impairment across academic, social and safety domains, and relevant developmental, family and records history.

Page two covers alternative explanations and coexisting conditions, the diagnosis and plan including baseline vitals before starting medication, and the monitoring interval, since ADHD is managed as a chronic condition. Two design choices carry the defensibility. The informant table asks for the same instrument from both a parent and a teacher, because using one instrument across two settings is what lets you compare rather than assert cross-setting impairment. And functional impairment gets its own section, separate from the symptom count, because a symptom count alone does not meet criteria. On coding, 96127 is reported per standardized instrument, so a parent form and a teacher form are two units. Optimized for use with Sully.ai's AI medical scribe, it helps streamline note-taking and improve clinical efficiency.